Provider Services Advisor / Medicaid - Remote

Description

Humana Healthy Horizons in Indiana is seeking a Provider Services Advisor (Market Development Advisor) who will be responsible for the strategic and tactical support of the Provider Services team. They will advise the Director, Provider Services on the day-to-day and strategic operations of the team, process development and improvement to drive standardization and efficiencies across the team. They will complete related state reports, develops and executes upon a provider communication and provider materials development strategy. Initially, the Provider Services Advisor (Market Development Advisor) will play a key role in supporting new market implementation activities. They will partner cross-functionally within the market and across the enterprise on matters of significance. This Provider Services Advisor (Market Development Advisor) exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. They use independent judgment requiring analysis of variable factors and determining the best course of action.

Responsibilities

• Advises Provider Services Director on strategic and day to day operations of the overall Provider Services team, which includes provider relations, claims education, provider engagement, and practice transformation functions.
• Establishes infrastructure to measure KPIs and other metrics to ensure compliance with related managed care contractual requirements.
• Develops initial and manage annual updates of the market’s Provider Support Plan, in partnership with the Director, as well as any other related required state reporting.
• Oversees provider communications (fax blasts, emails, bulletins, website, or provider portal content updates) end to end process, including development of content and management through the approval process.
• Manages provider training and education strategy, including advising on and/or creating market-based provider materials and contributing to provider manual and required training materials.
• Prior to market go-live, contributes to implementation of contractual requirements and day-to-day business processes/functions.
• Leads process development or improvement and communicates them to team members to drive efficiencies, standardization, and best practices for Indiana.
• Drives development of ad hoc strategic initiatives to execute on the Medicaid Long-Term Services and Support (LTSS)/Home and Community Based Services (HCBS) provider journey, provider relationship management model, and other strategic initiatives.
• Facilitates workgroup calls/meetings/discussions to ensure successful execution of Provider Support Plan.
• Partners with corporate Medicaid Provider Services team to rollout new segment-wide process or technology enhancements in support of the overall Provider Services team.

Required Qualifications

• Must reside in the state of Indiana.
• Must be able to travel in the state of Indiana.
• Bachelor's degree.
• Five (5) years of related experience, including provider relations or engagement, provider communications and education, and/or related health plan operations.
• Two (2) or more years of project management experience.
• Proven experience writing and delivering presentations to members of leadership teams and internal business partners
• Strategic thinker with the ability to identify, prioritize, and solve complex business problems.
• This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

• Master’s degree.
• Experience working in Medicaid.
• Familiarly with LTSS/HCBS providers and/or DSNP/Medicaid-Medicare integration.
• Strong understanding of health plan operations.
• Experience operating in a matrixed environment.
• Project management certification.

Additional Information:

• Workstyle: Remote, but may vary due to travel and occasional onsite work at the Humana Healthy Horizons office in Indiana.
• Travel: Up to 15% travel in the state of Indiana to provider offices and Humana locations.
• Core Workdays & Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time(EST).
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes; 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....
• Direct Reports: 1

Job Type: Full-time

Pay: $93,000.00 - $116,300.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Paid training
• Tuition reimbursement
• Vision insurance
• Work from home

Schedule:

• 8 hour shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

Experience:

• provider relations or engagement, provider communications: 5 years (Required)
• project management: 2 years (Required)

Willingness to travel:

• 25% (Required)

Work Location: Remote